Why Doulas Are Expensive (and why you're glad they are)

My husband is a deal-hunting guru - master of the coupon - king of the discount. He receives approximately 1,384 daily emails for deals, coupons, sales, etc. in our area. We were early-adopters on the Groupon/Living Social bandwagon - like so early, it was awkward. So when I, a shiny new doula, informed him that we, eight weeks pregnant, needed to start interviewing doulas, he was a bit confused. “Sweetheart, doulas are so expensive. And you just became a doula - maybe you can just doula yourself?”After the enlightening [read: bossy] conversation that ensued, he was soon, albeit hesitantly, in agreement that we needed a doula. I spent all of my 30 hours of early labor at home, and most of my six hours of active labor there as well. I continued to delay calling my doula, not knowing how much longer I would be laboring, and certain that I needed that “tool” in my tool belt to realize my goal of an unmedicated, birth center birth. My doula met us at the birth center, and two and a half hours later my daughter was born in the water and placed on my chest. Now, I won’t break it down for you (though my husband might) what it cost us per hour to have doula support for my final 2.5 hours, but what I will tell you: It was worth every single penny. And, even more amazing, my cost-conscious husband agrees. And when you take into consideration the following facts, it becomes even more unbelievable:

I am a doula and well-researched birth nerd.

I had my daughter at a birth center, a place that basically maintained my “birth plan” as their standard practices - I was not going to have to “fight” for any of my preferences.

With my incredible husband and amazing mom there as support in addition to my doula (and her doula assistant), I had quite the birth team.

Every couple is faced with the same question when they’re building their “birth team” - Are doulas worth the investment?In honor of World Doula Week, we’re going to cover just a few of the reasons doulas are not cheap (why you wouldn’t want them to be) and why they are one of the best investments you can budget for and commit to for your labor.

Six Reasons Doulas aren’t Cheap (and why they're worth it):1. Time.Most doulas don’t charge per hour, and we should be so grateful! Not only does average labor last between 12-18 hours (and many much longer than that!), but your doula also typically provides prenatal and postpartum meetings, likely lasting between 1-2 hours each. Not to mention the countless texts and phone calls with clients at all hours of the day. Regardless of if your labor lasts 3 hours or 53, your doula has committed to provide you continuous support.

2. The Doula Bag - tools of the trade. Like the “Mary Poppins” of labor, it’s amazing what a doula can pull out of her doula bag to support couples in labor. From essential oils and rebozos, to birth balls and hot pads, this gear is not cheap, but can dramatically transform a mom’s experience of labor. Though some doulas don't carry insurance, most professional doulas do. 3. Being on call is hard - really hard.Professional doulas commit to being on call the two weeks before and after a client’s due date (if not more). This may not sound like a big investment, but being on call is an exhausting lifestyle. It’s a life that requires last minute cancellations of dinner dates, long stints away from family, limiting travel plans, saying no to that second glass of wine, and severely disturbed sleep (whether from labor support or the waiting game). Living with your phone in your hand and your foot out the door is challenging on individuals, marriages and family units.

4. Childcare. If your doula is also a mom, her being at your prenatal/postnatal appointments and labor means she is also coordinating and likely compensating someone else to care for her children. If she’s not fortunate enough to have a doting grandma nearby, this can be a huge out of pocket expense. 5. Training and continuous education. Doulas invest in themselves and in their clients by enhancing their skills with continuing education - whether it’s aromatherapy, massage, belly casting, photography, lactation support, reflexology, spinning babies, etc., there is an unending list of skills and tools a doula has access to to better prepare her to support her clients. These trainings require an investment of both money and time (more childcare costs).

6. Time is not scalable. Even the best doulas are limited by the number of hours in a day. Doulas can only take so many clients per month without increasing the likelihood of missing births and calling on backups. A professional doula utilizing her skills to make a living wage is very different than one who takes a few births a year. She has honed her skills with each birth, built relationships with doctors, nurses and midwives, learned the “ins and outs” of specific hospitals and birth centers, and has a world of experience to draw from for each birth. To say “yes” to a birth is to say “no” to a million other things, including another source of income/job. So…now you know just a few reasons doulas aren’t cheap.

But are they worth it?Yes. A hundred times yes. And there are actual statistics to prove it. According to a study of over 15,000 laboring women conducted in 2012 to test the difference continuous support during labor has on the labor experience, women who experienced continuous support during labor were:

More likely to have a spontaneous vaginal birth

Less likely to utilize pain medications (general and regional) during labor

Had shorter labors

Less likely to express dissatisfaction with their birth experiences

Less likely to have a cesarean

Less likely to have an assisted vaginal birth (forceps or vacuum)

Less likely to have a baby with a low five minute Apgar score

The same study also revealed that continuous support was most effective if the support person was not on staff at the hospital nor a part of the woman’s social network. The author’s conclusions of this study are perhaps the most poignant summary of the importance of a doula: “Continuous support during labour has clinically meaningful benefits for women and infants and no known harm. All women should have support throughout labour and birth.”Well said, Dr. Hodnett, well said.REFERENCES: 1. http://www.ncbi.nlm.nih.gov/pubmed/23076901DISCLAIMER: We are not saying every high-cost doula is amazing and every low-cost doula isn't - cost is not always a predictor of level of service. Interviewing multiple doulas is an essential part of finding the right fit for your personal needs and preferences.